TITLE:
Factors Affecting Success of Laparoscopic Salpingostomy for Tubal Ectopic Pregnancy: One Hundred Case Experience
AUTHORS:
Basem Hamed, Amina Nagy
KEYWORDS:
Laparoscopy, Ectopic, Salpingectomy
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.12,
December
6,
2019
ABSTRACT: Objective: The aim of this work is to predict those patients
who will have a successful laparoscopic salpingostomy from those who will be
obligated to go for salpingectomy. Methods: This study included 100 cases of diagnosed ectopic pregnancy in low parity women
and was prepared for laparoscopic salpingostomy versus salpingectomy. Clinical
data were collected from the patients (parity, gestational age and clinical
presentation), b-hcg, ultrasound data (vascularity of the mass, viability of
fetal pole and site of the ectopic in relation of the ipsilateral ovary),
laparoscopic data (presence of mass invasion of the tube, free fluid in Douglas
pouch, start of tubal abortion and site of ectopic). Then we started to do
salpingostomy on the antimesenteric
border of fallopian tube using the spatula with monopolar diathermy and try to
remove the conceptus from the tube with hydro dissection and check bleeding
from the implantation site, only cauterization of the edges of the tubes at the
site of salpingostomy was allowed. The process was called to be successful if
no more bleeding from the fallopian tube and tubes were conserved, but it was a failed procedure if too
much bleeding from the bed of fallopian tube and laparoscopic salpingectomy was
done. Results: 28 cases (28%) had laparoscopic
salpingostomy (success group) and 72 cases (72%) failed salpingostomy and we went for
laparoscopic salpingectomy (failure group). 67 cases with the ectopic in the medial 1/2 of the tube (from which 15
case had salpingostomy and 52 cases had salpingectomy) and 33 cases with ectopic in the lateral 1/2 of the tube (from which 12 cases had salpingostomy and 20 cases had salpingectomy) with no
significant difference in both groups (P value 0.075). 42 case showed start of
tubal abortion of which 24 cases (57.2%)
had salpingostomy and 18 cases (42.8%)
had salpingectomy with highly significant difference between both groups (P value 0.000). 52 cases
during laparoscopy showed invasion of the mass to the fallopian tube and
impending tubal rupture, from this group 21 cases had salpingostomy and 31 cases had salpingectomy. Conclusions:
In tubal pregnancy, presence of non-viable fetal pole together with signs of
start of tubal abortion and presence of mild free fluid in Douglas pouch and no
mass invasion of the fallopian tube can effectively predict the success of
laparoscopic salpingostomy and tubal conservation with no need for
salpingectomy in low parity females.